B 형 간염 환자에서의 Delta agent 의 감염상

이헌주(Heon Ju Lee),정문관(Moon Kwan Chung),김종설(Chong Suhl Kim),최정규(Jung Gyu Choi),강찬규(Chan Kyu Kang),박화종(Wha Chong Park),최수봉(Soo Bong Choi) 대한소화기학회 1987 대한소화기학회지 Vol.19 No.1

N/A Delta agent is known to be highly infectious to HBV carriers. Despite of the high prevalence of HBV infection in Korea, only few studies of delta infection has been reported and its results are different from foreign study. Therefore authors evaluated the prevalence of delta infection by the sera from 40 HBsAg positive patients with various liver diseases, who consist of 15 patients with chronic active hepatitis, 10 with chronic persistent hepatitis, 3 with liver cirrhosis, 3 with hepatocellular carcinoma and 9 with acute viral hepatitis. Following results were obtained: 1) Anti-delta was detected in only 1 case of 40 cases. 2) It is suggested that delta infection is still rare in Korea despite of high endemicity of HBV infection.

비 미란성 역류 질환의 치료에 주석산 시사프리드와 돔페리돈 말레이트의 비교 임상 연구 ( 다기관 연구 )

장병익(Byung Ik Jang),김태년(Tae Nyun Kim),정문관(Moon Kwan Chung),김성국(Sung Kook Kim),허정욱(Jung Wook Huh),임창영(Chang Young Im),김호각(Ho Gak Kim),서정일(Jung Il Suh),이문호(Moon Ho Lee),김남재(Nam Jae Kim),윤세진(Sei Jin Youn) 대한소화기기능성질환·운동학회 2002 Journal of Neurogastroenterology and Motility (JNM Vol.8 No.1

N/A The therapeutic requirements of patients with non-erosive reflux disease (NERD) are similar to those with erosive esophagitis. The pharmacological action mechanism of prokinetics is quite different; domperidone is a peripheral dopamine D2-antagonist and cisapride is a HT4-agonist. This study was performed to evaluate the therapeutic effect of these two different prokinetics in patients with NERD. Methods: 178 patients, with heartburn and/or regurgitation, without reflux esophagitis were enrolled and divided into 2 groups by randomization code. In this prospective multicenter trial, 178 patients (93 patients in cisapride group, 85 patients in domperidone group) received 10 mg of cisapride three times a day or 10 mg of domperidone three time a day for 2 or 4 weeks. Symptom assessment was performed in each patients before treatments, 2 and 4 weeks after treatment. Results: Of the 133 patients available for final analysis, 65 were allocated to the cisapride group and 68 to the domperidone group. After 2 weeks treatment, heartburn was reduced in 81.1% of cisapride group, 56.7% of domperidone group (p<0.05) and regurgitation was reduced in 89.7% of cisapride group, 77.7% of domperidone group. After 4 weeks treatment, heartburn was reduced in 94.3% of cisapride group, 88.7% of domperidone group and this difference was not significant. The proportion of adverse events in cisapride group was 9.4% and was 5.5% in domperidone group. Conclusions: Cisapride tartrate was more effective in relieving heartburn in NERD patients than domperidone maleate after 2 week treatment. However, this superior effect dose not persist longer than 2 weeks.(Korean Journal of Gastrointestinal Motility 2002;8:3-13)

술중 담도조영술이 꼭 필요한가?

김춘직(Chun Jik Kim),김상운(Sang Woon Kim),이수정(Soo Jung Lee),김홍진(Hong Jin Kim),심민철(Min Chul Shim),권굉보(Koing Bo Kwun),정문관(Moon Kwan Chung) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.1

N/A Since operative cholangiography was introduced by Mirizzi in 1932, surgeons have used it routinely during cholecystectomy to find silent CBD stones. However, recent developments in preoperative evaluation techniques have led to debates regarding the routine use of operative cholangiography. The purpose of this study is to evaluate the necessity of the routine use of operative cholangiography. Of the 839 patients who underwent cholecystectomy, 625 patients underwent preexp- loratory cholangiography during the period from June 1983 to December 1991, at the Depart- rnent of Surgery, Yeungnam University Hospital. Unsuspected common duct stones were found in 5 out of 149 patients(5.9%) by preexploratoty cholangiography when emergency cholecystectomy was performed. Of the 448 cholangiography in patients without any abnor- mality in the preoperative test and no operative indication for CBD exploratiOn, the incidence of gall stones was only 1.1%. Of the 82 patients with minor abnormality of LFT or ultrasonogram, 38 cases of elective cholecystectomy were carried out without any other test. The incidence of gall stones in these patients was 28%. The ERCP was attempted on 163 pa- tients with one or more of the following abnormalities: LFT, ultrasonogram and past history of jaundice, pancreatitis or cholangitis. In 117 of these patients, CBD stones were found, in 2 of the patients, stricture were found, and in the rernaining 44, no stones were found. The ERCP performed on 35 patients with normal findings of preopeative LFT or ultrasonogram showed no evidence of CBD stone. Of the 79 whose ERCP was judged normal preoperatively, no stones were found at operative cholangiography. Therefore the following points may be concluded: First, operative cholangiography should be performed when emergency cholecystectomy is indicated. Secondly, it should also be done when the confirmatory test, such as ERCP, PTC and CT was not performed or failed in pa- tients with one or more of the following abnormalities such as LFT, ultrasonogram and past history of jaundice, pancreatitis or cholangitis. Finally, it should also be carried out on patients with dilated duct, small stones in the gallbladder and enlarged cystic duct.(Korean J Gastroenterol 1994; 26: 167-174)

대장암에서 Cdx2 단백발현의 의의

백종해 ( Jong Hae Pack ),김태동 ( Tae Dong Kim ),오현아 ( Heun Ah Oh ),이은주 ( Eun Joo Lee ),김준환 ( Jun Whan Kim ),장병익 ( Byung Ik Jang ),김태년 ( Tae Nyeun Kim ),정문관 ( Moon Kwan Jung ),배영경 ( Young Kyung Bae ) 대한소화기학회 2005 대한소화기학회지 Vol.46 No.3

목적: Cdx2는 최근에 알려진 유전자로 intestine-specific transcription factor를 암호화하고 인체에서는 소장과 대장의 상피 세포에서 특이적으로 발현되며 장상피세포의 성장과 분화에 중요한 역할을 한다. 원발 대장암에서 Cdx2 단백발현 이상이 보고되었고, 종양억제 유전자로 작용할 것이라는 연구 결과가 있다. 이에 저자는 침윤 대장암 조직에서 Cdx2 단백발현 정도를 측정하여 한국인 대장암에서 Cdx2 단백발현 소실의 빈도를 알아보고, Cdx2 단백발현 유무와 대장암의 임상병리 특징과의 관련성을 분석함으로써, Cdx2 발현정도가 대장암 발생 및 종양의 표현형 결정에 어떤 영향을 미치는지 알아보고자 하였다. 대상 및 방법: 영남대학교 의과대학 부속병원에서 대장암으로 수술한 환자 420명의 종양 조직 및 유방암, 정상 대장, 간, 위, 폐, 신장, 난소 조직을 대조군으로 하여 면역조직화학염색을 이용하여 Cdx2 단백 발현을 조사하였다. 결과: 환자의 90.5% (380/420)에서 Cdx2 단백발현이 관찰되었으며, 이 중 83% (349/420)는 강양성, 7.5% (31/420)는 약양성이었다. 대조군으로 사용한 145개 유방암 조직 모두에서 Cdx2 단백발현은 관찰되지 않았으며, 정상 간, 신장, 폐, 난소 조직도 모두 Cdx2 면역조직화학 염색에 음성이었다. 정상 위 점막에서는 장형화생을 동반한 부위에 국한되어 Cdx2 발현이 관찰되었다. 종양 인접 부위에 존재하거나 대조군으로 사용한 정상 대장 점막조직에서는 100%에서 Cdx2 단백발현이 관찰되었다. 임상병리 특징과 Cdx2 단백발현과의 관계는 종양의 침윤이 깊을수록(p<0.05), 림프절 전이가 있는 경우(p<0.001), 원격전이가 있는 경우 그리고 조직분화도가 낮을수록(p<0.001) Cdx2 단백발현이 의미 있게 감소하였다. 결론: 종양의 악성도와 Cdx2 단백발현 소실과는 밀접한 관련성이 있으며, 따라서 Cdx2가 대장 및 직장암의 예후인자로 유용한 역할을 할 수 있을 것이다. 또한 Cdx2 단백은 장세포 기원의 암종에 매우 특이한 표지자로서, 전이 암종의 원발 장기 규명에 이용할 수 있을 것으로 생각한다. Background/Aims: The caudal-related homeobox transcription factor, Cdx2, plays an important role in proliferation and differentiation of intestinal epithelial cells. Its expression is confined to normal and neoplastic intestinal epithelium. We evaluated Cdx2 expression in advanced colorectal cancers to determine the correlation between Cdx2 expression and clinicopathologic characteristics. Methods: Four hundreds twenty consecutive colorectal cancers were included in the study. Cdx2 expression was investigated by immunohistochemistry using tissue microarrays constructed from surgically resected specimens. 145 invasive breast cancers, normal tissues from gastric mucosa, liver, lung, kidney and ovary were used as control. Nuclear staining was considered to be positive and the result was divided into 3 categories. Results: In the colorectal cancers, Cdx2 was expressed in 380 of 420 (90.5%) cases, and 349 of 380 (83%) cases showed strong and diffuse staining and 31 of 420 (7.5%) cases showed weakly positive staining. Forty patients (9.5%) of colorectal cancer were negative for Cdx2. All of the invasive breast cancers and all non-neoplastic control tissues except the regions of intestinal metaplasia in gastric mucosa, which showed strong Cdx2 expression, were negative for Cdx2. Loss of Cdx2 expression was observed more frequently in cases with deeper invasion (p<0.05), lymph node metastasis (p<0.05), poor histologic differentiation (p<0.001), and distant metastasis (p<0.05). Conclusions: Cdx2 could be a highly sensitive marker to detect metastasis from intestine and might be useful as a novel prognostic marker in colorectal cancers. (Korean J Gastroenterol 2005;46:204-210)

상부위장관 출혈 원인의 변화 양상

김태년,도병수,김현정,이삼범,정문관 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.2

Upper gastrointestinal(UGI) bleeding was critical disease that was commonly found in emergency department and needed more early diagnosis and rapid treatment for decreasing mortality and morbidity. It's causes and frequencies were affected by many factors, but the majorities were caused by peptic ulcers and esophageal-gastric varices. With development of economy and medical services, new drugs and endoscopic interventions, the treatment of patients with UGI bleeding was more improved. So I would like to evaluate the change of causes and frequencies of UGI bleeding and the associated clinical findings. A total of 1,546 patients presented with UGI bleeding in emergency department of Yeungnam university hospital during the five years from Jan. 1991 to Dec. 1995 were clinically reviewed by chart and compared with previous seven years report from Jan. 1984 to Dec. 1990 in the same hospital. The ratio of male to female was 6.1:1 and slightly increased in comparison with previous seven years. The incidences in 6th and 5th decades were highest(54.4%)as like as previous seven years. Age distribution of duodenal ulcer bleeding, Mallory-Weiss tear and acute gastric mucosal lesion were developed in lower decades than the others. The causes of UGI bleeding were caused by esophageal varix(45.4%), peptic ulcer(38.8%), Mallory-Weiss tear(4.3%), gastric cancer(3.8%), other(3.1%), acute gastric mucosal lesion(2.7%), undetermined causes(1.8%) in descending order of frequencies. The proportion of esophageal varices was increased from 36.6% to 45.4%, but that of peptic ulcer was relatively decreased from 47.6% to 38.8%. And the annual distribution of varices was increased, however the annual distribution of peptic ulcers was increased. Although the ranking of annual distribution of gastric ulcers and duodenal ulcers were not changed compared to previous study and the frequency of gastric ulcers was increased since 1992, but additional follow-up was needed. Seasonal variations were found that upper gastrointestinal bleeding was increased in fall and peptic ulcer bleeding was increased significantly in summer and fall, however, varix bleeding was less frequent in summer time as like as previous seven years. Emergency endoscopic examination was performed within 6 hours for 54.5%, 24 hours for 90.8% and this results were to be like previous results, 57.5% and 90.7 respectively. Findings of emergency endoscopic examination were active bleeding focus(21.2%), blood clot(7.9%), exposed vessels(13.3%), flat blood spot(6.4%) and lesion without evidence of bleeding(51.3%). Endoscopic findings of active bleeding were easily seen when examination was perfomed within 24 hours. Blood transfusion was performed in 67.3% with average 2.1 units. When the causes of bleeding were due to varix and marginal ulcer, more amounts of blood were transfused than the others. In previous seven years, blood transfusions were performed in 71.2% with average 5 units and more amounts of blood were transfused in gastric cancer and varix bleeding.

연 중독의 임상적 고찰

이정미,이형우,현명수,정문관,심봉섭,이현우 영남대학교 의과대학 1989 Yeungnam University Journal of Medicine Vol.6 No.2

5예의 연중독 환자를 경험하여 다음과 같은 결과를 얻었다. 1. 남자가 3예, 여자가 2예였다. 2. 납중독의 원인은 개인적 원인에 의한 환약 복용이 3예, 직업성 중독이 2예였다. 3. 입원 당시 4예는 위장증상을 주소로 입원하였고 복통, 변비, 복부팽만을 호소하였으며 장연동음의 감소를 관찰할 수 있었다. 1예는 위장증상없이 빈혈을 주소로 입원하였다. 4. 전 예에서 빈혈과 망상적혈구의 증가(평균 4.7%)와 호염기성 반점을 관찰할 수 있었고 혈색소의 평균치는 9.2gm/dl이었고 정구성, 정색소성 빈혈이었다. 5. 골수천자를 시행한 4예 모두에서 적혈구계의 증식이 있었고 호염기성 반점을 관찰할 수 있었고 평균 M : E 비는 0.72 : 1이었다. 6. 혈중연은 4예에서 증가되어 있었고, 24시간 소변 연, ALA와 CPP는 전 예에서 증가되어 있었다. 7. 복통 및 빈혈은 Ca-EDTA 투여 후 호전되었다. 5 cases of lead poisoing were investigated clinically. Of the 5 patients, 4 were male and 1 was female. The causes of lead poisoning in 3 cases were ingestion of herb drug pills and in 2 cases were occupational poisoning. Chief complain at admission in 4 cases were ill defined colicky abdominal pain and constipation. Only 1 case complained of dizziness and palpitation without gastrointestinal symptom. On peripheral blood, normocyticnormochromic anemia(mean Hgb 9.2gm/dl), reticulocytosis(mean 4.7%) and basophilic stippling were found in 100% of patients. Bone marrow aspiration was done in 4 cases. Erythroid hyperplasia and basophilic stippling were found in all 4 cases. Mean M : E ratio was 0.7 : 1. The lead concentration in serum was increased in 4 cases(80%) of patients. Lead concentration, deltaaminolevulinic acid concentration in 24 hours collected urine were increased in 5 patients(100%) Qualitative test of coproporphyrin of urine was positive in all 5 cases. 3 patients treated with Ca-EDTA, abdominal pain was improved rapidly and hemoglobin level was increased slowly.

백서에서 출혈성 쇽이 장내세균 전위에 미치는 영향

김봉준,정문관,김태년,정성복,권순욱,최교원,장병익 대한소화기학회 2001 대한소화기학회지 Vol.37 No.3

Background/Aims: The aim of this study was to determine whether bacterial translocation could be demonstrated after experimental hemorrhagic shock in rat and whether translocated bacteria have a pattern of distribution within the major organ system. Methods: Male Sprague-Dawley rats were randomly assigned to hemorrhagic shock group (group I, n=20), sham shock group (group II, n=20) and normal control group (group III, n=15). At 24, 48, 72 hours after shock, rats were sacrificed and bacteria in their major organs were cultured. Results: The incidence of cultured bacteria in group I were highest. In the group I, enteric bacteria were cultured at mesenteric lymph node of 15 rats (75.0%), liver of 10 rats (50.0%), spleen of 4 rats (20.0%), lung of 4 rats (20.0%), portal vein of 4 rats (20.0%). The most common cultured bacterial species was E. coli. The bacterial translocation seemed to increase significantly in lungs at 48 and 72 hours after shock (p$lt;0.05) and cecal mucosal injury occurred after shock. Conclusions: Bacterial translocation was induced in hemorrhagic shock model. The identification of cultured organism in major organs supports the bacterial translocation from gut. Hemorrhagic shock could impair mucosal barrier, which may promote bacterial translocation.

간기능 검사상 이상을 보인 환자에서의 HBV 표식자 발현 양상

최정규,이용원,최진명,정문관,이헌주,김종설 영남대학교 의과대학 1985 Yeungnam University Journal of Medicine Vol.2 No.1

저자들은 급성간염 39예, 만성간염 79예, 간경변증 30예, 원발성간암 16예, 보유자 14예 및 비교군 129예의 모두의 307명을 대상으로 하여 SGOT,SGPT및 HBV 표식자를 조사하여 다음의 결과를 얻었다. 1. HBsAg의 발현율은 급성간염의 66.7%, 만성간염의 63.3%, 간경변증의 36.7%, 원발성간암의 81.3% 및 비교군에서 27.1%인 것으로 나타났다. 2. AntiHBc의 발현율은 급성간염의 0%, 만성간염의 21.5%, 간경병증의 36.7%, 원발성간암의 31.3%, 보유자 0% 및 비교군에서 44.2%였다. 3. HBeAg은 만성간질환중 만성간염에서 45.6%로 가장 높게 나타났고 AntiHBe는 원발성간암에서56.3%로 가장 높았다. 4. AntiHBc는 각종 간질환, 보유자 및 비교군에서 높게 나타났으며 이는 AntiHBc자체는 간질환에 직접 관계가 없는 감염의 흔적으로 생각된다. 5. HBsAg 보유자 14명중 6명 (42.3%)에서 혈청 GOT, SPT치의 이상 상승이 있었다. 6. HBV에 감염된 혈청학적 증거가 있으면서 간기능에 이상이 있을때, HBV 이외에 non-A, non-B바이러스, Delta agent 또는 타 바이러스나 관련된 다른 요인과의 관계가 있을 수 있는 점을 고려하여야 할 것으로 생각된다. HBV의 5가지 표식자가 모두 음성으로 나타난 환자는 급성간염의 5.1%, 만성간염의 5.1%에 달했으며, 이것은 HBV 이 외의 다른 원인이 병인이 될 수 있음을 시사하며 비교군중 SGOT, SGPT치의 증가를 보인군에서는 17.6%, 정상 SGOT, SGPT치를 나타내는 군에서는 12.8%에서 모든 HBV 표식자가 음성으로 나타났다. Serum HBsAg, AntiHBc, HBeAg, AntiHBe and AntiHBC were detected by radiommunoassay in 39 patients with acute viral hepatitis,79 patients with chronic hepatitis,30 patients with liver cirrhosis 16 patients with primary hepatocellular carcinoma,14 patients with HBsAg carriers and 129 cases of controls: 78 cases of normal level of SGOT, SGPT and 51 cases of elevated level of SGOT, SGPT. Following results were obtained: 1. HBsAg was detected in 66.7% of acute viral hepatitis, 63.3% of chronic hepatitis, 36.7% of liver cirrhosis, 81.3% of primary hepatocellular carcinoma and 27.1% of controls 2. AntiHBs was positive in 0% of acute viral hepatitis, 21.5% of chronic hepatitis, 36.7% of liver cirrhosis, 31.3% of primary hepatocellular carcinoma, 0% of carrier and 44.2% of controls. 3. HBeAg was detected in 45.6% of chronic hepatitis, 23.3% of liver cirrhosis and 31.3% of primary hepatocellular carcinoma. 4. Among chronic liver disease ,AntiHBe was positive in 56.3% of primary hepatocellular carcinoma, 23.3% of liver cirrhosis and 20.3% of chronic hepatitis. 5. AntiHBc was detected in most of all examines and the significance of presence of AntiHBc does not seem to represent liver disease itself but the evidence of infection of HBV. 6. Among 14 HBV carriers, 6 cases presented with abnormal SGOT, SGPT. 7. All HBV markers were negative in 5.1% of acute viral hepatitis, 5.1% of chronic hepatitis and 14.7% of controls: 17,6% of subjects with abnormal SGOT, SGPT and 12.8% of subjects with normal SGOT, SGPT. 8. Beside of HBV, other causes, such as non A, non B virus, Delta- agent, other viruses of related factors should be excluded among the patients with evidence of HBV infection associated with elevation of SGOT & SGPT.

소세포폐암에 동반된 Eaton-Lambert Syndrome 1례

이경희,정문관,현명수,정재천,이현우,하정상,변영주 영남대학교 의과대학 1989 Yeungnam University Journal of Medicine Vol.6 No.1

저자들은 영남대학병원에 입원한 52세 남자환자로서 임상소견, 조직소견, 근전도 소견상으로 소세포폐암과 동반된 Eaton-Lambert증후군으로 진단된 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Eaton Lambert syndrome(ELS)is a disorder of neuromuscular transmission. The defect of neuromuscular transmission is due to decrease in the release of acetylcholine guanta from nerve terminal. This syndrome is frequently associated with bronchogenic carcinoma. The diagnosis is established by electromyography, which characteristically shows 1) low amplitude of evoked compound muscle potential to a single supramaximal stimulus on nerve, 2) significant decremental response at low rates of stimulation 3) marked incremental response at high rates of stimulation. Our patient is 52 year old man with dyspnea, coughing and muscle weakness of proximal lower limbs. He has small cell lung cancer and associated with ELS, Superior venacava syndrome and has metastatic lesion on right supraclavicular lymphnode confirmed by pathology. Metastatic mass and SVC syndrome are marked improved following chemotherapy and radiotherapy, however follow up EMG finding dose not improved. We are here reporting one case which considered compatible for ELS, with a few elementary reviewed literatures.

식도암에서 화학요법 및 방사선 동시치료 효과와 예후인자

이은정,이경희,김태년,김성목,최재혁,정문관,현명수,김병덕,이상엽,김명세 대한소화기학회 2000 대한소화기학회지 Vol.35 No.1

Background/Aims: The prognosis of esophageal cancer has been exceedingly poor. Recently, many studies demonstrated that combined chemotherapy and radiotherapy improved the survival. In this study, we analyzed remission rate, survival rate, recurrance rate, and prognostic factors of the esophageal cancer retrospectively. Methods: Twenty-six patients with esophageal cancer who received chemotherapy with radiotherapy were included in this study. Radiotherapy was undertaken with 180 cGy per day upto 6500 cGy. All patients received two cylces of chemotherapy and the additional 2-4 cycles of maintenance chemotherapy (cisplatin 75 mg/m2 IV on the first day and 5-FU 1,000 mg/m2 for four days) after radiotherapy. Results: For the 26 patients, overall response rate was 61.6%. One year and 2 year survival rate was 66.1% and 41.7%, respectively and median survival was 89 weeks. Recurrence rate was 42.3%. The observed toxicity of this combined modality were nausea in 76.9%, leukopenia in 61.5%, mucositis in 53.9%, pneumonia in 21.3%, and esophageal stenosis in 23.1% of the patients. Conclusions: This combined modality improved the response rate and median survival. Additionally, clinical stage, performance status and the response to treatment were identified as important prognostic factors.